B4 School Check hearing screening and middle ear disease: a five-year analysis of prevalence and inequity
Thomas Oliver1, Alexia Searchfield2, Emmanuel Jo3
1Otolaryngology Registrar, Department of Otolaryngology, Health New Zealand - Te Whatu Ora Waitaha, Christchurch.
Insights
New Zealand
Area of Science:
- Public Health
- Audiology
- Pediatrics
Background:
- The B4 School Check in Aotearoa New Zealand screens four-year-olds for hearing loss.
- Otitis media with effusion (OME) is a common cause of hearing impairment in young children.
- Inequities in healthcare access may disproportionately affect certain demographic groups.
Purpose of the Study:
- To determine the prevalence and distribution of hearing loss in four-year-olds.
- To assess inequities in access to hearing screening and primary healthcare.
- To inform improvements in the B4 School Check programme's design and delivery.
Main Methods:
- Analysis of five years of hearing and demographic data.
- Regression analyses to identify disparities in disease burden and healthcare access.
- Examination of screening, referral, and primary care engagement patterns.
Main Results:
- Māori and Pacific children, and those in high deprivation areas, had lower screening rates.
- These same groups exhibited higher hearing disease rates and poorer primary healthcare access.
- Delayed referrals were more common in under-screened and underserved populations.
Conclusions:
- Current hearing screening delivery is inequitable, missing high-need children.
- Redevelopment is needed to ensure universal screening and equitable care.
- Integrated care models addressing ear health, speech, and housing are recommended.
Aim:
The B4 School Check includes hearing screening of four-year-old children in Aotearoa New Zealand. This study describes the prevalence and distribution of hearing loss, likely due to otitis media with effusion (OME), to determine if there is inequity in access to screening and primary healthcare, and to inform programme design and delivery.
Method:
Hearing data over a five-year period were linked with demographic data and interrogated using regression analyses for differences in disease burden, access to screening and to primary healthcare.
Results:
Māori and Pacific children and those living with higher deprivation were less likely to be screened. When screened these children had higher rates of disease, were less likely to be referred immediately and had poorer access to primary healthcare to enable appropriate management.
Conclusion:
The current delivery of hearing screening is inequitable, missing those that need it most and exacerbating an uneven distribution of disease burden. A redeveloped programme to enable identification and screening of all eligible children, differential delivery according to need and a more holistic provision of care is required. This includes support for speech and language concerns, ear health promotion and linkage with primary care and healthy housing programmes.
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